Job Description
Job Summary
The Prior Authorization Pharmacist will play a critical role in evaluating pharmaceutical prior authorization requests for one of the nation s largest Medicaid-focused health insurers. Working fully remote, this contract position enables pharmacists to apply clinical and regulatory criteria to make coverage determinations, support medical necessity reviews, and engage with providers. This is an ideal bridge opportunity for pharmacists seeking experience in managed care and pharmacy benefit management.
Key Responsibilities
- Make timely and accurate coverage determinations on prior authorization requests using established clinical criteria and benefit guidelines
- Assess medical necessity and ensure compliance with Medicaid, Medicare, and PBM regulations
- Communicate with prescribing providers to obtain additional clinical information and support determinations
- Provide clinical support to customer care teams and participate in peer review processes
- Support fraud, waste, and abuse oversight programs
- Maintain up-to-date knowledge of regulatory changes, operational directives, and industry trends
- Work independently, with access to senior pharmacist guidance as needed
- Participate in a rotating weekend schedule based on business needs
Skills
medicare, medicaid, specialty pharmacy, PBM, prior authorization, formulary, PharmD, appeals, coverage determination, medical necessity, step therapy, quantity limits, utilization management, utilization review, pharmacy benefit management, managed care, Part D, drug utilization review, DUR, fraud waste and abuse, FWA, RPh, pharmacist license, clinical criteria
Recruiter Insights
- Fully remote contract; no onsite requirement major competitive advantage for attracting talent nationwide
- Low barrier for entry: prior authorization experience preferred but not required; active pharmacist license is essential
- Provides a clear bridge for retail or hospital pharmacists moving into managed care and remote PBM roles
- Gained PA experience unlocks future remote opportunities in a growing telepharmacy market
- Competitive pay recommended at $60 $66/hr; role is market-aligned for a 3-month contract
- Note: Firm end date due to business transition (assignment ends December 31); disclose verbally to candidates
Candidate Insights
- 100% remote role work from anywhere in the US
- Opportunity to gain high-value managed care and prior authorization experience
- Ideal for pharmacists seeking to break into remote PBM roles or transition out of retail/hospital staffing
- Supportive peer and supervisory team, with focus on professional development
- Exposure to Medicaid and Medicare pharmacy operations, expanding career prospects
- Short-term contract (3 months) provides flexibility and resume enhancement without long-term commitment
Role Impact & Expectations
This position directly impacts patient care and drug access by ensuring appropriate medication utilization through evidence-based review. Pharmacists will exercise independent clinical judgment while adhering to regulatory and quality standards, making this a critical function within pharmacy benefit management. The expectation is for prompt, accurate, and compliant decision-making in a fast-paced, fully remote environment.
Job Tags
Contract work, Temporary work